Disclaimer: I'm not a medical professional. I share experiences and research I've read on this site to help others troubleshoot their hormone and cycle problems. Please seek diagnosis and treatment from licensed medical professionals.
If you've been following my story on this site, you may already know about my 10-year saga with hormonal birth control, coming off the pill, losing my period and getting erroneously diagnosed with PCOS. I don't wish that journey on anyone, but my experience did lead me down a long and fascinating educational path, which taught me a lot about fertility and hormone health. After 18 months with no period, a move to grad school and a switch in doctors, I learned in January 2020 that I'd gotten myself into quite the hypothalamic amenorrhea pickle.
Hypothalamic Amenorrhea (HA) is the prolonged absence of one's period for more than 6 consecutive months that can be attributed to a disruption in the hypothalamic-pituitary-adrenal (HPA) axis caused by: overexercise, undernutrition, extreme stress, or any combination therein.
Women experiencing HA typically have lower body fat percentages that normally cycling women, but this is not always the case*.
Although HA is common among top-performing athletes, you do not have to be an elite athlete to lose your period due to HA - I certainly wasn't!
Think this might be you?
Assuming you've come to this page because you already know you have HA - or at least you strongly suspect it (HA is a diagnosis of elimination), you're probably wondering..."is this something I even need to deal with?" After all, on the surface it's pretty convenient to lose your period, right?
Wrong.
While even doctors often praise women that are highly active and act unconcerned at the prospect of losing one's period due to living a "healthy" lifestyle, this couldn't be less true.
Studies have shown that losing one's period due to HA causes serious long-term health consequences, like higher heart disease risk and decreased bone mass density, to name a few*. I've written about these health implications in greater detail here.
Being "too fit" "too skinny" or "too stressed" to cycle is not an ~*aesthetic*~ it's an indicator of a serious health issue.
If you're anything like me, learning about the gravity of not cycling with HA will send you right into problem-solving mode. You'll want to get your period back ASAP!
Ironically, jumping in is the last thing you need to do when you have HA. Truly, for many women the hardest part about recovering from HA is quite simply, slowing down. By definition, this disruption in cycling has come your way because you pushed too hard or deprived your body in some way of the energy it needed. The core implication for your HA recovery will be that you need to reverse those lifestyle factors.
Here are 7 practices I implemented and tools I used on my "all-in" recovery journey:
1. Eat. More. Food: Typical consensus among HA experts is that women should eat at least 2500 calories per day in recovery. When I was diagnosed with HA, I was concurrently referred to a nutritionist at my university who could counsel me on how to add 10 lbs in a healthy and non-restrictive way. While I never actually scored an appointment (eye roll at American healthcare), I was already well researched on nutrition and simply ate more of the healthy, nutrient dense foods I already loved.
2. Rest Up: Possibly an even harder pill for me to swallow than the recommendation that I eat more was the consensus among HA experts that I needed to seriously slow down the exercise in order to recover my cycle. I put an exercise hold on my calendar for two full weeks, not allowing myself to book a hot vinyasa class or even go for a 20 minute jog. The science here really indicates that you need to flood your brain with "you have enough energy" vibes by both eating more and exercising less to solve that H-P-A axis disruption.
3. Stop Drinking Alcohol: The reason that stress is such a critical factor in HA is because of the "stress hormone," cortisol. Cortisol is a key messenger to the H-P-A axis and too much cortisol from stress is a primary factor in causing HA. But, did you know that drinking alcohol consistently or in excess also is shown to cause a cortisol spike?* Since I wanted to do everything in my power to boost the odds of a fast HA recovery, cutting out alcohol for a few weeks made my to-try list.
4. Turbo-charge Your Sleep: When you're stressed out, you're likely to experience more poor quality and interrupted sleep and that negative quality sleep is likely to amplify your cortisol response*. It's an unfortunate negative feedback loop, and one you'll want to focus on regulating during your HA recovery. While I personally had enjoyed using melatonin as a sleep aid for about a year prior to my HA diagnosis, learning that melatonin itself is a poorly regulated (by the FDA, that is) hormone made me want to stop ingesting it*. Focus on a more natural approach to winding down slowly and keep as consistent a bedtime as possible to boost your odds at better quality sleep and fewer cortisol (stress hormone) spikes.
5. Supplement with Ashwagandha to Lower Stress: Ashwagandha root extract, often also called Indian ginsing or winter cherry, has been used in Aryuvedic medicine for thousands of years to decrease stress and increase energy. Recent studies confirm the historical use of ashwagandha root to reduce chronic stress and specifically diminish cortisol levels*.
6. Use the Fertility Awareness Method to chart your temperature, cervical mucus (CM) and cervical positioning. This will tell you whether there are any "signs of life" that your cycle is returning. Although not a recovery tactic in and of itself, I found charting to be one piece I could truly control. And because I had been calorie counting for so long, channeling my need for control away from counting calories and into tracking fertility signs was a nice 1:1 swap.
7. Find Someone You Can Lean on For Accountability: This last tip might seem fluffy, but it's truly been the most critical facet of my HA recovery journey.
Decreasing exercise and amplifying the number of calories taken in each day can feel scary for the type-A, control-loving typical HA patient (me). I worked hard for several years to get as active and "healthy" as (I thought) I was, so putting my all into reversing that "progress" felt...awful, initially. I relied heavily on listening to others' experiences recovering from HA on YouTube and various podcasts, but ultimately, only had the accountability of myself and my partner to rely upon for recovery. Having someone to remind you that your recovery progress is forward progress, not backward progress, and that you're beautiful and worthy of a cycle, may be critical for you, too.
*Resources:
Study: Hypothalamic Amenorrhea and Long-Term Health Consequences
Study: Connection between alcohol consumption and increased cortisol levels
Study: A Prospective, Randomized Double-Blind, Placebo-Controlled Study of Safety and Efficacy of a High-Concentration Full-Spectrum Extract of Ashwagandha Root in Reducing Stress and Anxiety in Adults